An Integrative Model of Aggression: The Role of Cognitions in Responses to Stressors in Forensic and Non-Forensic Populations

This PhD aimed to further the understanding of aggression through the integration of research findings with theoretical models. As a result, a Stratified Integrated Model of Behavioural Aggression (SIMBA) that specifies and stratifies the roles of stress, cognitive structures and information processing was proposed. This may help guide therapeutic interventions aimed at the reduction of aggressive behaviour and inform risk assessment. A systematic literature review of 77 papers was conducted to assess the relationship between stress systems’ activity and aggression. The results showed that this relationship is likely present and can be both positive and negative. Thematic analysis of these papers identified six themes: 1) the impact of testosterone on the relationship between activity of stress response systems and aggression is undetermined; 2) the presence of sex differences in the relationship between stress response and aggression depends on the stress system and type of aggression; 3) specific disorders do not influence the relationship between stress and aggression; 4) experience of victimisation does not have a clear influence on the relationship between stress systems’ activity and aggression; 5) the relationship between stress response markers and aggression differs among those with high stress exposure; and 6) history of aggression affects the relationship between stress response markers and anger-based aggression. These results highlighted that the stress-aggression relationship is present, but is likely to be indirect. However, the extraneous variables consistently affecting this relationship were not identified. Addressing this issue, study one recruited 20 male students and 11 patients from a high secure hospital to establish the effects of aggression supportive cognitions and stress on aggressive behaviour. To assess aggression after a stress-evoking task, the Taylor Aggression Paradigm was used. It was predicted that while the presence of aggressive Implicit Theories (ITs) would be positively associated with aggressive behaviour towards a stranger, the association of stress would differ between the samples. This was partially supported, as only one specific IT (“I am the law”) was associated with aggression. Furthermore, only elevated skin conductance, but not changes in the heart rate, during the stress task was positively associated with aggression, and only among patients. Study two involved 100 participants (49 men, 48 women, three not disclosed) with an average age of 29. It aimed to investigate the relationship between history of aggressive behaviour, affective states, and neutral and emotional information processing. Event Related Potentials (ERPs) during a Go/No-Go task were utilised to capture cognitive resources allocation, with a “supervisor – employee” laboratory paradigm used to assess aggression. Contrary to expectations, results showed that trait aggressiveness was only related to aggressive behaviour at higher levels of inhibitory processing. The hypothesis that artificially provoked changes in negative and positive affect would be related to aggressive behaviour was also not supported. However, as expected, feeling hostile was associated with short-lived aggressive behaviour, but only for those who had low response inhibition. Moreover, partially supporting expectations, a history of aggressive behaviour moderated the relationship between change in negative affect and aggressive behaviour. The last hypothesis, proposing emotional processing to be a mediator between response inhibition and aggressive behaviour, was also not confirmed. Study three included 462 participants, of whom 300 were adults aged 26 or older (151 men, 149 women), and 162 representing transitional aged youth, aged between 18 and 25 (21 men, 141 women). This study aimed to identify direct and indirect effects exerted by aggression supportive cognitive structures, working memory problems, and stress on aggression by building a Structural Equation Model. It was expected that a direct cognitive pathway from aggression supportive cognitions directly to aggression would be identified. This hypothesis was supported. Meanwhile, the second hypothesis proposing an indirect relationship between stress and aggression was only partially supported, with maladaptive coping style being the only mediator identified. The current research demonstrated that aggression-supportive cognitive structures are the primary facilitators of aggressive behaviour. Meanwhile, the effect exerted by situational demands is contingent on the preferred coping style. Furthermore, despite the indirect nature, the influence of information processing was present for multiple precursors of aggression. Consequently, all these elements were included in the SIMBA and are suggested as primary targets for therapeutic aggression interventions. The results are discussed with attention to this proposed model, capturing further directions for future research

Burnout syndrome in the Czech Republic: The decreasing trend over the years

IntroductionBurnout syndrome is a state of long-term work exhaustion that manifests on three levels: cognitive, physical and emotional. Research regarding burnout syndrome has spiked in recent years. Despite burnout syndrome not being a clinical diagnosis, it has been recognized as a significant reason for work absence or, in some cases, even work leave. This study examines trends in burnout in the Czech population. The main aim of this research was to fill in the burnout literature gap and document the burnout trend over the years. Our secondary aim was to see if there is awareness regarding burnout syndrome and whether, over the years, we will see an increasing or a decreasing trend in burnout prevalence.MethodsData collection took place in three waves using the computer assisted web interviewing (CAWI) method. In 2014 n = 1,027, in 2017 n = 1,024, and in 2020 n = 1,000. Respondents were selected from the European National Panel. Because the target group was adults (18–65 years), an online survey was chosen. Internet penetration in this target population is sufficient, and it was not necessary to use a combination of methodologies.ResultsThe results suggest a decreasing tendency for burnout syndrome in the Czech Republic. Knowledge about burnout syndrome is increasing, suggesting that people are paying more attention to their mental health and the possible factors that might affect the severity of burnout syndrome.ConclusionOverall, burnout threatens the general population, not only medical employees. It is a positive finding that over the years, there has been an increasing trend in awareness about burnout. It further shows that people have adopted certain precautions and steps to avoid burnout syndrome as the perceived threat from it gradually decreases

Factors Affecting Length of Inpatient Forensic Stay: Retrospective Study From Czechia

Objectives: The length of forensic stay (LoS) is a subject to country-specific legal and service systems. Therefore, the identification of common factors targetable by treatment is at the forefront of forensic psychiatric research. In this study, we present the first reports of forensic characteristics of patients from the Czechia. Methods: We conducted a retrospective analysis of data from 260 inpatients discharged from the Bohnice Hospital (Prague) and obtained a set of sociodemographic and clinical variables as well as the Health of the Nation Outcome Scale (HoNOS) and HoNOS-secure scores. Results: The following variables were identified as significantly associated with a longer LoS: older age, length of previous psychiatric hospitalization, olanzapine equivalent, clozapine treatment, psychosocial dysfunction, psychotic or paraphilic disorder diagnosis, and sexual offense. A shorter LoS was associated with being in a relationship, being employed before hospitalization, receiving personal support, and committing an index offense under the influence of substance. While the HoNOS score and HoNOS symptom subscale predicted a longer LoS, the HoNOS-secure subscale predicted a shorter stay. Conclusion: In the European context, our hospital has a relatively low LoS. The results are consistent with findings linking psychotic disorders and paraphilia with a longer LoS in forensic treatment. Higher doses of antipsychotic medication or clozapine prescriptions were associated with a longer LoS. The results show a high level of unmet needs in this population, highlighting the importance of the availability of follow-up service

The centrality of cognition and coping styles in driving aggressive responses

Objective: Despite the presence of theoretical frameworks explaining aggression, they still require refinement in the form of a specification of mechanisms that facilitate such behaviour. Method: Study 1 recruited participants (N=31) from the general population (N=20) and from a forensic hospital (N=11). It was expected that aggression supportive cognitions and stress would be positively associated with aggressive behaviour. An experimental paradigm was used to induce stress and participants were subsequently given the opportunity to aggress. Study 2 was based on self-report questionnaires in community sample (N=462). It was expected that aggressive behaviour and traits would be associated with experienced stress, hostile attributions, coping styles, and attitudes to violence. Specifically, that criminal attitudes to violence will mediate the effect of hostile attribution on aggression, while coping styles will mediate the effect of perceived stress. Results: An Implicit Theory “I am the law” was found to be associated with aggression. Furthermore, elevated skin conductance, but not changes in the heart rate, during the stress task was positively associated with aggression, and only among patients. Structural Equation Model confirmed the mediating role of criminal attitudes to violence and of maladaptive coping style for aggressive behaviour. Conclusion: Aggression-supportive cognitions and maladaptive coping style are specific mechanisms through which external demands or subjective perception of a situation can result in aggressive behaviour

Stress-induced impairment in goal-directed instrumental behaviour is moderated by baseline working memory

Acute stress has been found to impair goal-directed instrumental behaviour, a cognitively flexible behaviour that requires cognitive control. The current study aimed to investigate the role of individual differences in baseline and stress-induced changes in working memory (WM) on the shift to less goal-directed responding under stress. To this end, 112 healthy participants performed an instrumental learning task. In phase 1, participants learned instrumental actions that were associated with two different food rewards. In phase 2, one of these food rewards was devalued by eating until satiety. Before the extinction test in phase 3, participants were subjected to the Maastricht Acute Stress Test or a no-stress control procedure. Results showed that the effect of stress on instrumental behaviour is modulated by baseline, but not stress-induced changes in WM capacity. Specifically, only at low baseline WM capacity did stress induce a shift to less goal-directed behaviour. These findings highlight that our cognitive resources are limited and for those who already have limited resources at baseline taking into account motivational value is impaired under stress. [Abstract copyright: Copyright © 2019. Published by Elsevier Inc.

Conspiracy theories: why they are believed and how they can be challenged

The current study aimed: (i) to identify personal characteristics associated with endorsing conspiracy theories; and (ii) to investigate methods for dispelling conspiracy beliefs. Participants were shown a single conspiracy theory and they also completed questionnaires about their reasoning skills, types of information processing (System 1 vs. System 2), endorsement of paranormal beliefs, locus of control and pattern perception. To challenge the endorsement of the conspiracy, participants read either: (i) neutral information; (ii) a critical analysis of the vignette; (iii) a critical analysis of the vignette with discussion of realistic consequences; or (iv) a critical analysis of the vignette with “feeling of control” priming. Only addressing the consequences of the conspiracy theory decreased its endorsement. Furthermore, only type of information processing and belief in paranormal phenomena, were associated with endorsement of the conspiracy. These findings are discussed in relation to previous studies and theories of conspiratorial ideation

Impacting on factors promoting intra-group aggression in secure psychiatric settings

Three preliminary and linked studies investigate the impact of making alterations to factors considered relevant to engaging in and experiencing intra-group aggression (bullying) among adult male patients detained in a single secure forensic hospital. Study one (n = 44) outlines the institutional factors, attitudes towards bullying and environmental factors that increase the likelihood of engaging in bullying and or being victimised. Study two (n = 56 patients and 113 staff) assesses the effect of three variations of intervention that aimed to reduce intra-group aggression through direct alteration of the physical and psychosocial environment, using data from both patients and staff. Study three (n = 414) looks at the effects of two variations of the intervention used in study two, which offered patients’ participation in individual and communal activities. It was predicted that changes to the physical and social environment would produce a reduction in the factors shown to predict intra-group aggression. Attitudes supportive of bullying and the presence of social hierarchies each increased the likelihood of engaging in bullying. Indirect changes to the social environment on the wards had more positive effects than those incorporating direct alterations to the physical and social environment. The differences in effectiveness of the two approaches are discussed in relation to the established predictors of intra-group aggression. The research concludes by noting the preliminary nature of the research and outlining potential directions for future research and interventions

A preliminary study exploring the nature of aggression supportive beliefs in a forensic psychiatric sample

Purpose: This preliminary study aims to investigate and describe aggression supportive normative beliefs among patients of a high secure hospital. Design: Therapy data from a sample of high secure forensic hospital patients (N = 11) who had participated in Life Minus Violence-Enhanced (LMV-E), a long-term violence therapy, was examined using Interpretative Phenomenological Analysis (IPA). During therapy, cognitions linked to past incidences of aggression were explored using Aggression Choice Chains (ACCs). Findings: IPA was applied to data generated through this process to examine the presence and nature of normative beliefs reported, identifying seven themes: Rules for Aggressive Behaviour; Use of Violence to Obtain Revenge; Processing Emotions with Violence; Surviving in a Threatening World; Do Not Become a Victim; Employing Violence to Maintain Status; and Prosocial Beliefs. Originality: Findings demonstrate that forensic patients have specific aggression supportive normative beliefs, which may be malleable. Limitations and implications are discussed

Predicting discharge from long-term forensic treatment: patients characteristics, protective factors, needs and treatment-related factors study in the Czechia

One of the challenges in forensic psychiatry is determining when an inpatient is ready to be discharged and return to the community. The comprehension of factors that predict extended treatment or discharge is relatively limited. We assessed the treatment progress of a cohort of forensic inpatients (N=80) divided into two groups: discharged patients and patients who remain detained. We derived socio-demographic and clinical variables from each patient’s medical records and scores on the HoNOS-Secure, GAF, and SAPROF scales. The dataset was subjected to logistic regression and Chi-square analysis to determine the relevant factors. We gained insights into illness as a strong predictor of discharge, which is also associated with the patient’s general compliance with the facility program and participation in occupational therapy. The majority of our sample has moderate or severe functional impairment according to GAF. The instruments used can capture dynamic factors related to discharge or continuing hospitalization, namely the SAPROF total or external factors score, the HoNOS-Secure subscale, and significant items from the HCR-20 clinical and risk subscales